Information on DM or Spinal Myelopathy in
GSD's

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Rosehall Kennel uses the results of genetic
testing to guide it's breeding program to ensure that there is no chance of our
puppies contracting degenerative spinal myelopathy. The following link
gives a relatively simple explanation of the condition and also has a good
explanation of the genetic link for the condition and how careful breeding can
eliminate the risk of a puppy having this problem later in it's life.
http://en.wikipedia.org/wiki/Canine_degenerative_myelopathy
We are seeking copyright permission to publish more detailed information here .
. . check back with this page from time to time for more information.

The web site at UF will be closed shortly, so the
link may go bad. It will come back on an educational, commercial site a
bit later. I still believe the web should be for free real education,
but I guess I got outvoted! The rule is only that it be free and that it
is still best to link. Here is what we tell people who inquire of us
about GSDM...

Unfortunately, we cannot offer the DM Flash test at
this time except for research purposes. We have included information
about the test and our typical workup for informational purposes as the
information is still correct.

New information is that we may have a genetic test
for the disease. We can run the test for people, knowing that it may be
negative in a number of suspect cases, since up to 75% of those with
clinical signs actually do not have GSDM. Your veterinarian can help you
with this by collecting the blood and arranging to send it to us. We
will provide the results within 2 weeks. We still feel it should not be
the sole diagnostic run for the disease, but it may go a long way toward
confirming the presence of GSDM.

The DM Flash test is not a good screening test for
this reason…there are too many false positive results due to a high
incidence of the change in the breed while only a limited (10-20%) of
the positives get the disease. However, that said, it does say that the
risk of developing GSDM is 12 times higher in dogs who are positive on
the DM Flash test than in dogs who are negative. A negative test
suggests there is a 99% chance the dog will not get GSDM. However, a
positive test in normal dogs has only an 11% predictive value.

In dogs with clinical signs of possible DM, the DM
Flash test is a good diagnostic test. It is 96% sensitive and 99%
specific and is generally going to separate those who have GSDM from
those who do not have it (only some other neurologic disease). It still
does not replace other tests since there may be more than one disease,
but it probably is sufficient to confirm the diagnosis of GSDM and move
the patient to the “probably GSDM” category. What this means is that a
positive DM Flash test means there is less than a 1% chance the dog does
not have DM as part of the clinical picture, while a negative DM Flash
test means that there is a 4% chance that the dog may still have GSDM
even though the test was negative. With a negative result, only
additional tests can be sure that GSDM is part of the disease process or
whether another disease is more likely.

So, while 91% of the proportional risk of
developing GSDM is accounted by having a positive DM Flash test
(genetics accounts for most of the reason the patient gets GSDM). A
positive test in a normal dog does not mean they will inevitably get
GSDM; just that they are at a greater risk. A negative test means it is
highly unlikely that the dog will get GSDM, but not impossible. That is
about as good as any test. Those who test positive are the ones who
should be watched and extra care taken with. We may ultimately find out
what other factors influence the genetics to lead to GSDM and then we
might be able to prevent the disease from happening. For now, all you
can say is there is a risk of developing GSDM and that might be a reason
to alter breeding, but only if other things are factored in as well.

Like families of MS patients, there is a risk that
others might get MS because of increased genetic risk. In dogs other
than German Shepherds, the DM Flash test may mean the same, but we do
not have enough data to say that. As such, we would cautiously recommend
that other diagnostics be performed in order to be sure the results are
accurate. While we expect that the results of the DM Flash test to be
similar in other breeds, only more numbers of patients and studies on
randomly-sampled dogs from that breed will answer that question.

Thank you for taking the time to email us about our
program on German Shepherd Dog Myelopathy (GSDM). We have studied this
disease over the last 30 years and continue to do so. Our current
program is unique and designed to improve the diagnosis of GSDM and
offer a sensible treatment for GSDM based upon what we know of the
underlying cause of the disease. Unfortunately, we cannot answer
specific questions about patients that we have not seen. The Internet is
not sufficient to establish a valid client-patient-veterinarian
relationship. We have offered our web pages (http://neuro.vetmed.ufl.edu/neuro/DM_Web/DMofGS.htm)
as a guide and educational resource for people who think their animal is
affected with GSDM. There is a lot of mis-information on the Internet,
we have tried to provide some sense to that. The information on our web
site is what we can currently offer and recommend to those patients we
have not seen. Our web site is where you can start. Yes, we have looked
at many treatments for GSDM, but what is on the web site is what we have
found to help most of the GSDM patients we see. Older versions of our
information have been replicated at other sites on the Internet. Our
pages are officially what we recommend and do. From our work and the
genetic data available on GSDM, we believe the evidence says that GSDM
is an animal model of Primary Progressive Multiple Sclerosis in human
beings. So, at least, we think we know what GSDM is when we separate
those who do have it from those who do not.

Part of our program is the diagnosis of the
condition. Unfortunately, it is correct that the only current method to
be absolutely sure is with a necropsy, which does not help patients
before death. We have established criteria that help us make accurate
diagnosis. I think that we do better than what has been reported by some
authors. Only 25% of the patients enrolled in their study were found to
have the disease. The complicating factors which confused the diagnosis
in that study would have been found by our criteria. So, what do we do.
Basically, they are routine clinical test, but applied in a specific
sequence to help us find out all of the patient's problems. First, is
the clinical examination. That includes looking at who the patient is.
If the patient is a German Shepherd, then there is a higher probability
that a chronic progressive spinal cord problem might be do to GSDM. If
it is not a German Shepherd, it may have a myelopathy, but it may be
from another cause. We are not sure that the disease in the Corgi or in
the Boxer is related to the disease in the German Shepherd. On the other
hand, we can distinguish the disease that Corgis, Boxers and Rhodesian
Ridgebacks get from GSDM based upon genetic aspects that these breeds
have that related to their form of DM. Since these diseases are
genetically different, applying our treatment to these breeds may not do
any good. The second criterion is based upon the EMG (electromyogram)
which evaluates the muscle-nerve connection. The EMG and all peripheral
tests of neuromuscular function are normal in uncomplicated GSDM. On the
other hand, the spinal cord evoked potential evaluated over C1 is
abnormal in GSDM. This indicates that there are problems in the white
matter of the spinal cord. We also look at the difference between the
cerebrospinal fluid (CSF) collected from the cisterna magnum and the
lumbar cistern. The latter shows elevations of CSF protein without
concurrent increases in CSF cell counts. While many of these proteins
are inflammatory in nature, one of the ones that can be measured easily
is CSF cholinesterase. The CSF cholinesterase is elevated in the lumbar
CSF (above 300 IU/ml) in most cases. Unfortunately, this change is not
specific for GSDM, only for inflammation (GSDM is one of the
inflammatory disease of the spinal cord). Titers for infectious diseases
are normal or, at least, do not indicate another disease process.
Finally, we look at special imaging to evaluate the structure of the
spinal column and whether there is evidence of spinal cord compression
from some disease process. This does not rule-out GSDM, rather imaging
rules-in complications. The former criteria are what help diagnose GSDM:
the clinical picture, the EMG with spinal evoked potential, and the CSF
analysis with cholinesterase. The imaging only looks for a surgical
disease (or its absence). Depending upon the condition and clinical
signs, we do myelography plus or minus CT scan or MRI scans to help us
determine whether there is a local compressive disease.

Not every neurologist does the tests that we do.
That might be why we have success, since we know better what we are
treating and also whether to treat a surgical problem or not. On the
other hand, there are other approaches to this disease and you will need
to follow what is recommended by those who have seen your dog. You
should, at least, see a neurologist and let them help you find out what
they can for your dog. Remember that without the proper tests, it is a
guess as to what is wrong. You can search for the closest neurologist at
http://www.acvim.org/.

The other part of our program is the treatment
outlined on our web site. It includes exercise, diet, supplements and
medications. Each of these has an impact upon health and upon the
disease. The components of the treatment work together to reduce the
progression of GSDM. They target the processes which we have uncovered
as the causes of the pathologic changes we see. We have seen few
side-effects (mostly GI upset) in the patients we diagnose and treat.
There are things which can happen as rare occurrences when using any
drug. If they complications resolve on stopping the drug and return on
re-introduction, then it is probably drug related. If your veterinarians
feel there is a problem, then the medications should be stopped until it
is determined whether they are the cause or not. Many times it is
discovered that some other disease is present rather than the
medications. All of the medications have been used in dogs for many
years (not just for treating GSDM) so they are not new. Only the
application is new. N-acetylcysteine is the newest and we have used it
for over 10 years. On the other hand, we do not like to use medications
unless we know what we are treating. So, we do not treat without
reaching a diagnosis. The 2 parts of our program, diagnosis and
treatment, work together. We diagnose early and treat early, which is
why we have success. In the past, most patients progressed to posterior
paralysis in 3-6 months. This would progress to all 4 legs in another
3-6 months with death from brainstem failure (in those patients allowed
to progress that far without intervention) 9-18 months from the first
diagnosis of GSDM. That has changed now. In our hands, most GSDM
patients will remain functional for 12 months, while many outlive their
disease.

If dogs respond well to the therapy, they should
continue on it potentially for life. However, if their condition is
stable for several months (at least 6 months), then decreasing the
medication (aminocaproic acid and acetylcysteine) to 2 twice a day on
days given can be attempted. If this works as well as 3 times a day and
they remain stable for another 6 months, then the dose can be reduced to
daily. Some cases may be able to maintain with diet and supplements
alone, but most cases will require continuous medication.

We apologize that we cannot help you more.
Certainly, we are happy to see patients at the Veterinary Medical Center
at the University of Florida (number below) by appointment. If that is
not possible, then follow the course that makes sense to you and your
veterinary team. They have seen your dog and know it far more than we
can via the Internet. We hope that you receive the care and treatment
that you need.

Sir: We raise large GSD’s and are concerned about DM. We use
genetic testing of our breeding dogs and never breed a carrier to a
carrier and are working towards having DM free breeding dogs. Our
marketing is web based:
www.rosehallkennel.com and we would like your permission to link
your 1998 article on DM on our site. Would also be interested in your
recommendations of other articles that you think would be helpful to our
buyers.